The patient began complaining of gum swelling, tenderness and pain on chewing. She presented to her dentist who diagnosed her with periodontitis following examination of the oral cavity. The patient underwent a deep cleaning at the treating dentist’s office. The procedure lasted almost two hours and involved removing plaque material from the affected teeth. The patient suffered a significant amount of bleeding during the cleaning. Once the bleeding had stopped the patient was discharged home. The treating dentist did not prescribe any prophylactic antibiotics after the procedure was completed.
Approximately two weeks after the procedure the patient developed stroke like symptoms including slurred speech and unilateral face droop. The patient was taken the emergency room by her husband. A neurosurgeon was consulted on the case and investigations revealed that the patient had contracted a staph viridans infection. The infection had caused a dental abscess to form which was the source of the patient’s neurological symptoms. The patient required a long hospitalization, surgery to drain the abscess and intravenous antibiotic therapy.
Question(s) For Expert Witness
What steps should a dentist take to prevent this type of infection? Are antibiotics supposed to be given before this type of procedure?
Expert Witness Response E-006410
Dental cleanings involve removing plaque and calculus deposits that have built up on the teeth over time. Teeth are continually bathed in saliva which contains calcium and other substances which help strengthen and protect the teeth. Over time this can cause a build-up of calcium deposits on the teeth. The deposits can gradually build up over time, similar to the lime scale residue on the inside of a kettle. If the scale, or calculus is allowed to accumulate on the teeth it will unfortunately provide the optimal environment for bacteria to thrive next to the gums. The purpose of the deep cleaning treatment is to leave the surfaces of the teeth clean and smooth so that bacteria are unable to adhere to them. The cleaning process involves the dentist or oral hygienist using a sharp tool to scrape away the scale from the surface of the teeth. This can cause bleeding of the gums, especially when there is a lot of build up around them. The overall medical status of the patient would potentially affect the risk of complications following any procedure performed. The extent of bacteremia following invasive dental procedures can vary. The fact that the patient experienced a significant bleed during the procedure should have raised a red flag. Antibiotics would have been indicated if there was a very aggressive periodontitis diagnosis or if there was a prosthetic appliance present that warranted coverage per the American Medical Association guidelines.
About the author
Dr. Faiza Jibril
Dr. Faiza Jibril has extensive clinical experience ranging from primary care in the United Kingdom, to pediatrics and child abuse prevention at Mount Sinai Hospital, to obstetrics in Cape Town, South Africa. Her post-graduate education centered on clinical research and medical ethics. Dr. Jibril is currently Head of Sales in the US and Canada for Chambers and Partners - a world leading legal ranking and insights intelligence company.
